DIGITAL HEALTH IS AN IMPERATIVE, NOT AN OPTION
Angelo De Rosa, Vice-president and General Manager Rhythm Management EMEA
Healthcare is a field where most innovations are created. For many years now and from applications to the internet of things, a lot is being done to help doctors monitor patients remotely. More broadly, digital health is one of the hottest topics of the moment and it's close to our hearts at Boston Scientific. While the Covid-19 pandemic has facilitated an unprecedented acceleration of digital health technologies, I am convinced that we can further explore the potential of these technologies in many medical specialties and in particular, remote patient monitoring (RPM) technologies in cardiac rhythm management.
It is precisely this area I wish to address here, questioning what meaningful difference RPM technologies would bring to healthcare systems, hospitals, physicians and ultimately to patients?
Before we begin, it is important to define what we mean by RPM technologies. These technologies “allow health providers to monitor disease and symptom progression remotely and then engage with patients [..] to modify care plans and to provide education on self-care, based on changes in the patient’s condition”.
Facilitating the management of chronic conditions
In Europe, four million people die each year as a result of a chronic disease (e.g., heart failure, asthma, diabetes), accounting for 85 percent of all EU deaths. These also have strong economic and social implications accounting for up to 80 percent of all healthcare costs.
In this area, RPM solutions promise to play a crucial role in facilitating the management of chronic conditions. Indeed, they could potentially be used to support diagnosis and screening. As such, these solutions should be an integrated part of healthcare systems and management. This has been shown specifically for remote monitoring during the COVID-19 pandemic, which became essential for supplementing traditional face-to-face interaction between healthcare professionals and patients.
By measuring specific health parameters and permanently monitoring health conditions, RPM solutions can play a key role in preventing the worsening of those conditions or even fatal episodes.
Easing burden on healthcare system
RPM clearly demonstrated benefits such as reducing the frequency of hospital admissions and thus reducing costs for healthcare institutions. Based on a study in France and Germany, healthcare digitalisation could result in efficiency gains of about €55 billion, which could equate to €120 billion if extrapolated for the entire EU-27, out of which 40 percent could be realised by supporting teleconsultation, remote monitoring of chronic diseases and unified electronic health records (EHR). RPM solutions would reduce administrative costs through more data-driven and collaborative decision-making processes including physicians and patients.
The future of cardiac care
I am particularly excited by the potential of RPM in cardiac care. It is well known that heart failure is a very prevalent health condition today due to a scissor effect of the ageing population as well as lifestyle factors that increase risk of cardiovascular diseases such as heart attacks. Indeed, one in five people are expected to suffer from heart failure in their lifetime. Heart failure is costly for the health care systems, amounting to 108 billion USD per annum globally. Heart failure is the leading cause of hospitalisations after giving birth to babies. RPM solutions in support of heart failure could provide a more personalised approach, with the potential to bring about better health outcomes for patients at lower healthcare costs, by ensuring timely diagnosis and treatment, therefore enabling the prevention of complications and potential hospitalisations.
Empowering patients to take control of their health and reducing inequalities
On the one hand, RPM has the potential to improve treatment and self-management of health conditions. In fact, thanks to continuous monitoring, patients can live more autonomously and with improved life quality. This can in practice make a big difference for patients as they can lead the life they want while knowing that someone else is watching over their health.
On the other hand, as we all know, waiting lists for specialist doctors are getting longer and longer and it is becoming common feature of the European health landscape. Indeed, the concentration of health care professionals and services in cities dramatically accentuates the disparities between urban centres and rural areas and, consequently, the need for health care services in the latter. According to Medtech Europe article : “RPM solutions proved to be an effective and often convenient alternative to face-to-face consultations or minor treatments in healthcare centres during the pandemic, particularly for groups of people who face restrictions in accessing healthcare centres due to geographical distance, age, physical conditions, or time limitations.”
Adequate funding for a more digital and value-based healthcare system
To unleash the full potential of RPM solutions important actions need to be taken by the various stakeholders involved. According to physicians, one of the main barriers for RPM adoption is reimbursement , to provide an adequate funding of RPM solutions and related medical activities. The European trade association representing the medical technology industries, Medtech Europe, recently published a background document on RPM, that reflects all the asks we have towards a more digital and value-based healthcare system.
The Time is Now!
A paradigm shift in healthcare systems is necessary to effectively address the emerging challenges and provide more effective care, especially in the area of funding the use of RPM solutions. Aligning healthcare pathways with the post-pandemic reality - considering increasing specific needs of people living with a chronic illness - is paramount. I am convinced that RPM technologies are part of the answer bringing an efficient, accessible, and quickly implementable solution when more than ever we need an inclusive and cost-effective healthcare system.
 According to National Library of Medicine: Chronic disease research in Europe and the need for integrated population cohorts - PMC (nih.gov)
 European Commission: Towards better prevention and management of chronic diseases (europa.eu)
 Hindricks G, Taborsky M, Glikson M, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384(9943):583-590. Doi: 10.1016/S0140-6736(14)61176-4. PMID: 25131977
 European Commission. Shaping the Digital Transformation in Europe.; 2020. Accessed February 15, 2021. https://ec.europa.eu/newsroom/dae/ document.cfm?doc_id=69479.
 Langabeer JR 2nd, Champagne-Langabeer T, Alqusairi D, et al. Cost-benefit analysis of telehealth in pre-hospital care. Journal of Telemedicine and Telecare. 2017;23(8):747-751. doi: 10.1177/1357633X16680541
 World Heart Federation. Epidemiology and risk profile of heart failure. Accessed November 26, 2021. https://world-heart-federation.org/resource/ heart-failure-infographic-2/
 Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschl. Sterbe- und Stundenfälle) - Fachserie 12 Reihe 6.2.1 - 2016 (destatis.de)
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 Treskes RW, Beles M, Caputo ML, et al. Clinical and economic impact of HeartLogic™ compared with standard care in heart failure patients. ESC Heart Fail. 2021;8(2):1541-1551. doi:10.1002/ehf2.13252
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 Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association - PubMed (nih.gov)